MEDICARE: MEMORIAL HEALTH SYSTEMS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1275640997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL HEALTH SYSTEMS INC

Provider Business Mailing Address
First Line	:	PO BOX 730729
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32173-0729
Country	:	US
Telephone Number	:	386-671-4500
Fax Number	:	386-672-9904

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 2811
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5999
Country	:	US
Telephone Number	:	386-671-4519
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	CORY DOMAYER
Credential	:
Telephone Number	:	383-231-3906

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/26/2021

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1518923093 — RENAE VAUGHN RN, MSN, ARNP-C
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1871537027 — DR. RAYMOND LOUIS WEIAND D.O.
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 2801
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32164-5999

Practice Phone: 386-586-1910
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1013002880 — PADMAJA SAI M.D.
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 2812 , FLORIDA CANCER SPECIALISTS P L
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1457555211 — MS. AURORA PICARDAT APRN
Practice Location Address:

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1457676207 — CARLY MELISSA HOLMES ARNP
Practice Location Address:

61 MEMORIAL MEDICAL PKWY STE 2815
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32164-5999

Practice Phone: 386-586-1810
Practice Fax:

Directions to “MEMORIAL HEALTH SYSTEMS INC ” Practice Location

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